title: Is aortic wall degeneration related to bicuspid aortic valve anatomy in patients with valvular disease?
abstract: OBJECTIVE
  Patients with bicuspid aortic valve are at increased risk for aortic complications.
  
  
  METHODS
  A total of 115 consecutive patients with bicuspid aortic valve disease underwent surgery of the ascending aorta. We classified the cusp configuration by 3 types: fusion of left coronary and right coronary cusps (type A), fusion of right coronary and noncoronary cusps (type B), and fusion of left coronary and noncoronary cusps (type C). Histopathologic changes in the ascending aortic wall were graded (aortic wall score).
  
  
  RESULTS
  We observed type A fusion in 85 patients (73.9%), type B fusion in 28 patients (24.3%), and type C fusion in 2 patients (1.8%). Patients with type A fusion were younger at operation than patients with type B fusion (51.3 +/- 15.5 years vs 58.7 +/- 7.6 years, respectively; P = .034). The mean ascending aorta diameter was 48.9 +/- 5.0 mm and 48.7 +/- 5.7 mm in type A and type B fusion groups, respectively (P = .34). The mean aortic root diameter was significantly larger in type A fusion (4.9 +/- 6.7 mm vs 32.7 +/- 2.8 mm; P < .0001). The aortic wall score was significantly higher in type A fusion than in type B fusion (P = .02). The prevalence of aortic wall histopathologic changes was significantly higher in type A fusion. Moreover, there were no statistically significant differences between type A and type B fusion in terms of prevalence of bicuspid aortic valve stenosis, regurgitation, or mixed disease.
  
  
  CONCLUSIONS
  In diseased bicuspid aortic valves, there was a statistically significant association between type A valve anatomy and a more severe degree of wall degeneration in the ascending aorta and dilatation of the aortic root at younger age compared with type B valve anatomy.
authors.affiliation: Angelo De Gasperis Department of Cardiac Surgery, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore, Milan, Italy.
authors.forename: Claudio F
authors.initials: CF
authors.lastname: Russo
authors.forename: Aldo
authors.initials: A
authors.lastname: Cannata
authors.forename: Marco
authors.initials: M
authors.lastname: Lanfranconi
authors.forename: Ettore
authors.initials: E
authors.lastname: Vitali
authors.forename: Andrea
authors.initials: A
authors.lastname: Garatti
authors.forename: Edgardo
authors.initials: E
authors.lastname: Bonacina
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities / Q000473:pathology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D002648:Child; D004108:Dilatation, Pathologic / Q000453:epidemiology / Q000473:pathology; D018450:Disease Progression; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000033:anatomy & histology* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D011379:Prognosis; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016896:Treatment Outcome